Asperger's disorder

Characteristics

People without autism (what people with Asperger's tend to call "neurotypicals" or "NTs") generally possess a very sophisticated sense of other people's mental states. Most people are able to gather a whole host of information about other people's cognitive and emotional states based on clues gleaned from the environment and the other person's body language[?]. Autists do not have this ability, and the individual with Asperger's can be every bit as "mind-blind" as the person with profound Kannerian autism. At best they will see a smile but not know what it means (is it an understanding, a condescending, or a malicious smile?) and at worst they will not even see the smile - or frown, or smirk, or any other nuance of communication. They generally cannot "read between the lines," that is, figure out those things a person is implying but is not saying directly. They often find eye contact in particular overwhelming and hard to understand the nuances of. Many make very little eye contact. This leads to more difficulties picking up emotions because it's hard to see and learn about things one isn't looking at. Some will make constant eye contact, not knowing what the standards for too much are, and perhaps trying to get every clue about a person's facial expression they can to compensate for their limited ability to understand that facial expression.

Asperger's Syndrome involves an intense level of focus for things of interest and is often characterized by special (while possibly peculiar) gifts; one person might be obsessed with 1950s professional wrestling, another with national anthems of African dictatorships, another with toilet brushes. Particularly common interests are means of transportation (for example trains) and computers. In general things with order have appeal. When these special interests coincide with a materially or socially useful task, the individual with Asperger's can often lead a profitable life - the child obsessed with naval architecture may grow up to be an accomplished shipwright, for instance. In pursuit of these interests, the individual with Asperger's often manifests extremely sophisticated reasoning, an almost obsessive focus, and eidetic memory. Hans Asperger[?] called his young patients "little professors", based on the fact that his thirteen-year-old patients had as comprehensive and nuanced an understanding, within their area of expertise, as university professors.

Autists have emotional responses as strong as, or perhaps stronger than, most "neurotypicals", though what generates an emotional response might not always be the same. What they lack is the inborn ability to express their emotional state via body language, facial expression, and nuance in the way that most neurotypicals do. Many people with Asperger's report a feeling of being unwillingly divorced from the world around them; they lack the natural ability to see the subtexts of social interaction, and equally lack the ability to broadcast their own emotional state to the world.

This leads to no end of troubles both in childhood and adulthood. When a teacher asks a child with Asperger's, "And did the dog eat your homework?", the child with Asperger's will remain silent, trying to figure out if they need to explain to the teacher that they don't have a dog and besides dogs don't generally like paper. The child doesn't understand what the teacher is asking, cannot infer the teacher's meaning or the fact that there is a non-literal meaning from the tone of voice, posture or facial expression, and is faced with a question which made as much sense to him as "did the glacier in the library bounce today?" The teacher walks away from the experience frustrated and thinking the child is arrogant, spiteful and insubordinate. The child sits there mutely, feeling frustrated and wronged.

In adulthood, the person with Asperger's may find it difficult to differentiate between the smiles of a waitress waiting on his table and the woman at the next table who's interested in him. He may well wind up asking the waitress out for a cup of coffee and ignoring the woman at the next table.

Asperger's Syndrome is not a death sentence, however - very far from it. Often their intense focus and tendency to work things out logically will grant them a high level of ability in their field of interest. Despite their difficulty with social interaction, many possess a rare gift for humor (especially puns, wordplay, doggerel, and satire) and written expression. In fact, their fluency with language is such that a number of them also qualify as hyperlexic. While their lives will probably not be considered a social success by the common standards and there are a large number who will remain alone their entire lives, it is possible for them to find understanding people (either also on the autistic spectrum or not) with whom they can have close relationships. While they face enormous obstacles, some manage to overcome them and prosper in society.

DSM definition

Asperger's is defined in section 299.80 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as:

1. Qualitative impairment in social interaction, as manifested by at least two of the following:
   1. Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
   2. Failure to develop peer relationships appropriate to developmental level
   3. A lack of spontaneous seeking to share enjoyment, interest or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
   4. A lack of social or emotional reciprocity
2. Restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:
   1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
   2. Apparently inflexible adherence to specific, nonfunctional routines or rituals
   3. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
   4. Persistent preoccupation with parts of objects.
3. The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.
4. There is no clinically significant general delay in language (e.g., single words used by age two years, communicative phrases used by age three years)
5. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills or adaptive behavior (other than in social interaction) and curiosity about the environment in chidhood
6. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

The Diagnostic and Statistical Manual's diagnostic criteria have been roundly criticized for being far too vague and subjective: what one psychologist calls a "significant impairment" another psychologist may call insignificant.

A series of studies have supported the thesis that there are in fact no or only very few cases that strictly meet the above DSM-IV definition of Asperger's: patients typically show communication impairment, which then qualifies them for a diagnosis of autistic disorder and not Asperger's. See [1].

Relationship to Autism

Experts today generally agree that there is no single mental condition called autism. Rather, there is a spectrum of autistic disorders (the "autistic disorder spectrum"), with different forms of autism taking different positions on this spectrum.

In the 1940s, Leo Kanner[?] and Hans Asperger[?], working independently in the United States and Europe, identified the polar ends of the autistic disorder spectrum. If the different autistic disorders were to be arranged according to the autist's ability to function effectively in society, Kanner's would run the gamut from no ability all the way to the so-called "high functioning autists", who may be capable of independent living. Asperger's begins where Kanner's leaves off, and runs all the way into autists who can compensate for their symptoms enough to conduct themselves normally in society.

Kannerian autism is characterized by significant cognitive and communicative deficiencies. Individuals with Kannerian autism show delays in or lack of language and may fall anywhere on the IQ spectrum, from genius to profoundly retarded. Often it will be clear that these people do not function normally. An individual with Asperger's on the other hand will have a normal to superior IQ and will not show delays in language. It is a more subtle disorder and affected individuals will often simply appear to be a little odd.

Kanner's syndrome is described in the article autism.

A high-functioning autistic may possess enough communicative and/or cognitive skills to function in society, but it will have come the hard way for them; they will have learned speech at a relatively late age (most likely somewhere between four and twelve) and it will remain a conscious effort. Whereas, by the very definition of Asperger's Syndrome, the individual with Asperger shows no significant cognitive/communicative deficiencies.

Some clinicians believe that communicative and/or cognitive deficiencies are so essential to the concept of autism that they prefer to consider Asperger's as a separate condition altogether from autism. This opinion is, so far, a minority one. Uta Frith (an early researcher of Kannerian autism) has written that people with Asperger's seem to have more than a touch of autism to them. Others, such as Lorna Wing and Tony Attwood, share in Frith's assessment.

Asperger's Syndrome and other forms of autism are often grouped together in a Pervasive Developmental Disorder[?] family.

Comorbid Disorders

There are many comorbid disorders associated with Asperger's Syndrome. (A comorbid disorder is a disorder which is often found in conjunction with another disorder, although neither may cause the other.) The major comorbid disorders associated with Asperger's include post-traumatic stress disorder, Sensory Integration Dysfunction, anxiety disorder, panic disorder[?], social anxiety disorder, obsessive-compulsive disorder (OCD) and depression. If a comorbid disorder is present with Asperger's, it often cannot be treated in the same manner as when it is present in neurotypicals.

Clinical depression is by far the most common comorbid disorder, affecting over half of all people with Asperger's, especially during early adulthood. People with AS attempt suicide at a staggeringly high rate in comparison to the general population, although whether this is due to AS or depression comorbid to AS is a matter of debate.

Effect on Spouses

The spouses of people with Asperger's are more prone to major depression than the general population because Asperger's people often have trouble showing affection or understanding the need to show affection, and are very literal and hard to communicate with in an emotional way. A spouse of a person with Asperger's will often go to the "well" to seek affection and find that the well is dry! It is very helpful for the spouses to read as much as they can about Asperger's syndrome, OCD, hyperlexia and other comorbid disorders. It also helps to visit the support groups' websites online and talk with other spouses of people with Asperger's Syndrome. A spouse will often be much less angry and/or depressed if they understand that the Asperger's symptoms are not intentionally directed at them, but that they are part of a mental disorder. That someone does not spontaneously show affection does not necessarily mean that they do not feel it. Thus the spouse will feel a lot less rejected and be a lot more understanding. Light will be shed on the nature of the misunderstandings. They may figure out ways to work around the problems, for example being more explicit about their needs.

External links

• http://autistics.org/
• Institute for the Study of the Neurologically Typical -- a parody by people with Asperger's Syndrome (http://isnt.autistics.org/)
• http://www.aspergia.com/
• http://www.aspergersyndrome.org/ O.A.S.I.S. (Online Asperger Syndrome Information and Support--comprehensive and well maintained)
• http://aspergerinfo.org
• http://www.wired.com/wired/archive/9.12/aqtest

References

[1] Mayes SD, Calhoun SL, Crites DL: Does DSM-IV Asperger's disorder exist?, Journal of Abnormal Child Psychology 2001 June;29(3), pages 263-271, online version (http://www.findarticles.com/cf_0/m0902/3_29/76558499/p1/article.jhtml)